2013 Proposed Medicare Fee Schedule Rule Released for Comment

2013 Proposed Medicare Fee Schedule Rule Released for Comment

In July, the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule for Medicare Part B services paid under the Physician Fee Schedule in CY 2013. The proposed rule may be found here/[3].
Academy staff and volunteers are analyzing the 765-page proposed rule and its implications for audiology and will submit comments to CMS prior to the September 4, 2012 deadline. A final rule, which will address comments submitted in September, will be issued by November 1, 2012 and will be effective for services performed on or after January 1, 2013. The Academy welcomes your feedback regarding audiology topics to be addressed in its official comment letter; please email us[4].

The following proposals have implications for audiologists:

Sustainable Growth Rate (SGR) and Conversion Factor
Medicare reimbursement is calculated through a formula, which consists, in part, of a Conversion Factor and a Sustainable Growth Rate. While CMS did not include a conversion factor in the proposed rule, the Agency did submit an estimate of the SGR and conversion factor to the Medicare Payment Advisory Committee (MedPAC), which was consistent with existing statute and would be applicable to Medicare payments for practitioners' services for CY 2013. CMS' estimate included a -18.9% sustained growth rate (SGR) and a -27.0% update to the conversion factor, which would result in a conversion factor of about 24.71. The combined impact of CMS' proposed changes for audiology would result in a -5% overall decrease in Medicare reimbursement. As has been the political trend for the last several years, Congress must intervene to prevent the reduction in reimbursement caused by the flawed SGR, which impacts all Medicare providers. Please contact your member of Congress regarding this issue by visiting the Academy's Legislative Action Center[5].Physician Quality Reporting System (PQRS)
Qualified professionals, including audiologists, who satisfactorily report on PQRS quality measures during 2013 may be eligible to receive an incentive equal to 0.5 percent of the total estimated Medicare Part B allowed charges for all covered professional services furnished during the applicable reporting period. In the proposed rule, CMS recommended including a total of 264 individual quality measures for reporting under the PQRS in 2013, which includes 14 new proposed measures and 14 measures CMS proposes to retire.
The Academy was disappointed to learn that, of the 14 measures recommended for retirement, two are audiology measures; specifically: 1) Referral for Otologic Evaluation for Patients with History of Active Drainage from the Ear Within the Previous 90 Days and 2) Referral for Otologic Evaluation for Patients with a History of Sudden or Rapidly Progressive Hearing Loss. CMS explains that the agency is accepting the recommendation of the National Quality Forum's (NQF) Measure Application Partnership (MAP) because these audiology measures are not NQF endorsed. The MAP report referenced by CMS titled,MAP Pre-Rulemaking Report: Input on Measures under Consideration by HHS for 2012 Rulemaking[6]. The Academy's comment letter will urge CMS to continue to include the above two measures as part of the PQRS program and defend inclusion of audiology measures in the program as medically necessary care coordination measures relevant to audiology.

CMS also states that, beginning in CY 2015, a payment adjustment of -1.5% will be applied to eligible professionals who fail to meet the satisfactory reporting criteria for 2013 PQRS claims defined by section 3002(b) of the Affordable Care Act (the health care reform bill). What this would mean for audiologists is that beginning on January 1, 2013, all claims submitted to CMS will be reviewed for satisfactory PQRS reporting, and those deemed to fail to meet the criteria will only receive 98.5% of the properly billed amount on submitted claims, an adjustment which will not be made until 2015. CMS is proposing that all eligible professional who bill services to Medicare must report on 50% of their patients using at least one (1) PQRS measure beginning in 2013 to avoid the payment adjustment. The Academy continues to monitor the impact of "satisfactory reporting" on reimbursement for audiologists under PQRS and will request clarification in our comments to CMS regarding the payment adjustment as applied to audiologists with a very limited number of quality measures on which to report. Further, the Academy seeks clarity as to the logistics of applying a 1.5% deduction two years after the 2013 claims are submitted (deduction in 2015 for 2013 claims).

Multiple Procedure Payment Reduction (MPPR) Policy
In an effort to increase efficiency in the Medicare program, CMS has been looking to identify areas in which to apply a multiple procedure payment reduction (MPPR) policy. The intent of this formula is to reduce reimbursement on multiple services provided by the same practitioner to a patient on the same day. In the proposed rule, CMS recommends extending this policy to cardiovascular and ophthalmology diagnostic services. CMS is also proceeding with applying the current MPPR policy for outpatient therapy services and for imaging services furnished in the same session by physicians in the same group practice. While audiology codes are not currently affected, the Academy continues to monitor the MPPR policy closely due to the potential for CMS to apply such a reduction to audiology codes in the future.

Other relevant topics include:

A proposal to increase payments to family physicians by approximately 7% and other practitioners providing primary care services by between 3% and 5%.

A proposal to include "additional preventive services" on the list of services that may be reimbursed by Medicare if certain statutory requirements are met, as determined by the national coverage determination process. Current services are represented by HCPCS G-codes.